In two of our past issues, the Alliance for a Healthier World’s executive manager, Benjamin Link, explored the “Global to Local learning” approach (April 2018 and June 2018) the Alliance is employing to address health inequities.
That approach was put into action recently as Link and Nancy Edwards Molello, program director for Operations and Strategic Initiatives at the Johns Hopkins Center for Health Equity, traveled to Kenya and Uganda on a partnership mission aimed at forming new collaborations with communities and schools of public health in East Africa.
“Several of the relationships I have in Kenya go back to 2012 and Nancy saw people in Uganda who she’s known for 15 years, so I think the mutual trust and respect of our relationships is important,” Link said. “Our Kenyan and Ugandan colleagues realize that we are there with the intention of learning together, and that shared goal and value we all place on these relationships – and our high level of trust -- is what strikes me as unique.”
So often, Molello said, researchers and public-health officials from resource-rich nations feel they have all the answers, and they fail to listen to community leaders and learn what interventions could have the biggest impact. She pointed to a past trip to western Africa when a local official showed her a facility designed for treating Ebola that was installed by a well-meaning resource-rich nation at a cost of half a million dollars. It is now empty and unused because the community can’t afford its upkeep, and its entire design was not conducive to how health care is delivered in that region.
“There were great intentions, but it’s just sitting there,” Molello said. “It was because the whole idea of co-development, the whole idea of both groups working together, didn’t happen. I think that’s what Global-to-Local really stands for: the global and the local communities working together to solve problems to help the world.”
Mutual value from two-way learning
Link added that a key element to this approach is understanding that solutions created in resource-poor contexts can be used to improve care in resource-rich settings.
“I’ve seen some really thoughtful and well-designed solutions for healthcare-delivery problems in resource-poor settings– some of them driven by scarcity but making full use of the tools at hand. And I don’t think anyone who’s familiar with the U.S. health care system would look at it and say we are an exemplar for how this should be done. We’re spending 18 percent of GDP on health care and getting fairly poor health outcomes for our money. And that’s being generous. So why would you look at that system and think we know best?” Link said. “We do know how to operate highly specialized, fee-for-service models and generate profits from health care services but if we’re in search of the most efficient solution for a given health care problem, it’s probably not found in the United States.”
Meanwhile Kenya has a comprehensive safety net through its National Health Insurance Fund, and Rwanda’s Mutuelle de Santé health insurance program has garnered high praise. And, resource-poor settings have led in many mobile-technology solutions for health care applications. For example, Link said, the SMS texts many of us in the United States receive to remind us of a doctor’s appointment or a prescription refill were first tested at scale in Sub-Saharan Africa with people who are HIV positive as part of a broad effort to keep them engaged in the healthcare system and remind them of appointments with care providers.
While in Kenya and Uganda, Link and Molello made a host of connections, including with
Officials at Makerere University School of Public Health in Uganda
Members of chamas (local micro-lending groups) in Kenya
Representatives from Baylor College of Medicine Children’s Foundation Uganda
Women from Young Generation Alive, a support group for HIV-positive children and adolescents in Uganda
Officials at Makerere University-Johns Hopkins University Research Collaboration (MUJHU)
Fruitful action resulting from East African trip
As a result of that trip, several representatives from Kenya and Uganda will be taking part in a workshop at Johns Hopkins later this month – co-sponsored by the Alliance and the Center for Health Equity -- designed to launch new collaborations based on existing relationships.
“It’s really going to be a true exchange of ideas, opportunities and challenges across many different cultures, different professional disciplines, and the trick for us is going to be engagement through listening and resisting the urge to jump right into problem-solving mode said Link. “Because our goal with this workshop is not to solve a given health equity problem that comes up in the discussion. The workshops is about knocking down walls and poking holes in silos to let information flow freely. The problem we are trying to solve is wrapped up in culture and language and preconceptions.”
Link said he refers back to the Alliance’s formal mission statement when thinking of what the Alliance hopes to gain from the upcoming two-day workshop, which will highlight many of the key processes that the Alliance uses to enable multi-sector teamwork focused on global health equity:
We convene a network of key stakeholders around health equity challenges
We facilitate meaningful and inclusive conversations and help build multiple-disciplinary teams
We support an enabling environment for equitable access to innovation, invention and knowledge generation
We seek out and form dynamic and mutually beneficial partnerships with individuals, communities and institutions in low- and middle-income settings
We provide resources aimed at addressing health inequities by connecting people and providing grant funding
Dr. Lisa Cooper, a Bloomberg Distinguished Professor in Health Equity and Director of the Center for Health Equity and a member of the Alliance’s Steering Committee, said that the workshop “is a manifestation of our work to promote health equity locally and on a global level.”
The Center’s multi-faceted approach integrates research, community activation, education, and policy translation. It equips change agents to take a global view of the problems they seek to address; to look for patterns and themes that suggest common causal and contributing factors to health inequities; and to leverage their global view of the factors that cause inequities, in combination with their intimate local knowledge, to promote health equity and positive change.
Tangible support to turn workshop ideas into reality
As part of the mission to support innovative ways to address health inequities, the Alliance and the Center for Health Equity will be awarding several $10,000 Spark grants to participating groups from the workshop who identify new areas to advance methods and practices in Global-to-Local work.
“Although it’s a modest amount of money, it can allow the teams to either fly [to Kenya or Uganda] or come back here, I think that has a big impact,” Molello said. “It allows the teams to work together on problems they’re trying to solve in their different locations that could then have bigger influences in obtaining more funding and getting larger grants.”
Link said that longer term, the workshop and Spark grants will “be our testing ground for new approaches we’re talking about: Global to Local learning, but also Female-Led Innovation, and reducing barriers to sharing data and important findings in the form of Open Science.”